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Inhaler Reminders Improve Adherence

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If you’re an asthma sufferer and you sometimes forget to use your inhaler, an electronic reminder could be the answer to keeping yourself on track. A study conducted by a research team at the Woolcock Institute of Medical Research in Sydney, Australia showed that reminders prompting asthma patients to take their control inhalers if they miss a dose significantly improved medication adherence, During the six-month investigation, patients receiving reminders took on average 73% of their prescribed doses compared to only 46% in patients who did not have reminders.

The results of the cluster randomized controlled trial were presented at the American Thoracic Society 2014 International Conference in San Diego. Given the fact that poor adherence is an important contributor to poor asthma control and that implementing strategies for improving medication-taking is sometimes impractical in primary-care settings, the study aimed to develop and test a set of adherence intervention tools that would be feasible for use by general practitioners.

A release from the society quotes lead author Juliet Foster, PhD as saying, “Adherence is often inhibited by patients’ concerns about medication effectiveness and short- and long-term treatment safety. Also to blame are the modern, busy lives that we all lead, which can make taking medication a challenge for people with asthma and other chronic conditions.”

In total, the 43 GPs who volunteered for the study enrolled 143 patients between the ages of 14 and 65 who had been prescribed a twice-daily control inhaler for at least one month and scored sub-optimally (<19) on the Asthma Control Test™, a five-question self-assessment tool used to measure asthma control. Individuals who had had a recent asthma exacerbation or who suffered from other chronic respiratory diseases were excluded from the trial. The researchers tested the effectiveness of two GP-delivered interventions designed to tackle forgetfulness and/or patients concerns about inhaler use. The study participants were split into four groups: one group received twice-daily inhaler reminders for missed does with adherence feedback through a device that allowed for customization of ringtones and ring times; a second group engaged in personalized adherence discussions with their doctors about key barriers to medication-taking; a third group received both interventions; and a control group received active usual care, a routine treatment based on an Australian government-incentivized primary care asthma management program.
All patients used an electronic inhaler monitor called SmartTrack that recorded the date and time of each puff and uploaded that information to a secure website. Reminder patients and their GPs could visit the site at any time to review their medication use, but data were collected covertly for those in the non-reminder groups to enable the researchers to reliably measure differences in adherence between intervention groups.
Patients in the personalized discussion groups completed a short questionnaire about barriers to controller inhaler use before talking to their doctor about their personal treatment concerns, setting asthma-management goals and identifying strategies with which to achieve them. GPs who delivered personalized discussions attended a two-hour in-person workshop on empathic communication and engaged in additional training by phone over the course of the study. GPs in this group also received a set of communication tools to help them support their patients and understand their treatment perspectives.